How the health care law has evolved

Here are some of the changes the Obama administration has made in the implementation of the Affordable Care Act without approval from Congress:

– April 2011: Awarded $6.7 billion in quality bonuses to Medicare Advantage plans rated as average, which would have gotten nothing under the original terms of the law. Critics said the move was politically motivated to shield Democrats from election year accusations of cutting Medicare.

– February 2013: Suspended new enrollments in the Pre-Existing Condition Insurance Plan, a transitional insurance program for the severely ill, to ensure that funding was available for current enrollees.

– July 2013: Allowed individuals to self-report their income and enrollment in employer-sponsored health plans as part of the marketplace signup process. The government now relies on statistically significant samples of enrollment applications to check the accuracy of claims.

– July 2013: Gave employers an additional year, until 2015, to meet the “employer mandate” requirement to offer affordable health coverage for all full-time workers.

– September 2013: Allowed members of Congress and designated congressional staff to use their federal health care contribution toward purchase of marketplace coverage.

– October 2013: Extended enrollment period for marketplace coverage by six weeks, to March 31, 2014, because of technical problems on the HealthCare.gov. website.

– November 2013: Granted a one-year extension of individual policies that were terminated or facing termination for noncompliance with the law’s new consumer protections and benefit requirements.

– December 2013: Allowed consumers with canceled policies to seek a waiver of the requirement that they have health insurance if affordable catastrophic coverage is unavailable.

– December 2013: Extended the Pre-Existing Condition Insurance Plan, due to expire on Jan. 1, 2014, by one month.

– January 2014: Extended the program through March.

– February 2014: Gave midsize employers until 2016 to provide affordable health coverage for all full-time employees and allowed larger employers to phase in their employee coverage requirements through 2015 and 2016.

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